Provider Demographics
NPI:1093189458
Name:JACOBS, DWAYNE (LPC, 6090)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LPC, 6090
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 1/2 LA RUE FRANCE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3103
Mailing Address - Country:US
Mailing Address - Phone:337-324-1902
Mailing Address - Fax:
Practice Address - Street 1:241 1/2 LA RUE FRANCE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3103
Practice Address - Country:US
Practice Address - Phone:337-324-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health